Ivan Pavlov, a Russian physiologist, developed the theory of classical conditioning at the turn of the 20th century. However, the original development of this theory could not have been further from its eventual applied role within behaviour therapy. Classical conditioning was discovered during an experiment into the digestive process of dogs, a study that would win Pavlov the Nobel Prize for Physiology/Medicine in 1904. In 1913, John Watson employed classical conditioning theory in the development of behaviourist theory. Watson’s theory was popular, as it offered an objective and measurable basis for human behaviour, an approach that was in stark contrast to the other predominant psychological theories of the time (Hawton et al., 1996 and Duncan, 2003a).

The second influential learning theory in the development of behavioural theory was operant conditioning. This outlines ‘the Law of Effect’, whereby a behaviour that is rewarded will tend to be repeated, and behaviour that is punished will diminish (Hawton et al 1996).

Burrhus F. Skinner, an American psychologist, developed Pavlov’s work by extending the principle of reinforcement. Previously, an action was considered to be reinforced if it increased or decreased behaviour. Skinner explored different types of reinforcers and consequences. It was observed that different types of reinforcers had different effects on behaviour, depending upon the nature of the action. Together, classical and operant conditioning provided the theoretical foundation for a variety of behaviour therapy interventions, mainly in mental health settings (Hawton et al 1996).

Whilst the benefits of behaviour therapy were widely recognized, the late 1960s and early 1970s witnessed a developing disillusionment with behaviour therapy as the theoretical shortcomings and practical failures associated with the approach came into focus. Such disillusionment, at least amongst some, supported the birth of another, related form of therapy known as cognitive therapy.

Automatic thoughts are habitual and plausible. They are the uninvited thoughts that pop into your head (e.g. ‘I’ll sound stupid if I ask a question in this class’). Everyone has automatic thoughts and it is likely that you will have some whilst reading this chapter (e.g. What am I having for tea? Is this going to help me with my assignment? When am I seeing my next client?). However, for clients, more often than not automatic thoughts will be negative in nature. Another characteristic of automatic thoughts is that they can be situation-specific — a client may be plagued by unhelpful automatic thoughts whilst in a stressful work situation and find it difficult to cope, whilst appearing to function without difficulty when in the home environment.

It is useful to understand the automatic thoughts a client is having, as these can have a direct impact on their presentation in sessions and their ability to carry out day-to-day life activities. Several techniques can be used to elicit automatic thoughts.

Where thoughts are recognized as being unhelpful, the therapist and clinician can work together to help the client to change the nature of their thinking — in the knowledge that this will help their behaviour. Importantly, changing thoughts is not the same as thinking more positively, which is unlikely in itself to lead to improved functioning (Greenberger & Padesky 1995). Challenging automatic thoughts is about gaining a sense of perspective on a situation, taking alternative perspectives and exploring new perspectives and solutions. Methods to challenge thoughts include:

These are conditional beliefs that we hold about ourselves. They may be unhelpful in nature (e.g. ‘I always make a fool of myself when I meet my friends in the pub’). Whilst automatic thoughts are often easily accessible, beliefs tend to be slightly less obvious. They can sometimes be inferred from individuals’ actions. If beliefs are to be put into words, then they often take the form of ‘if … then …’ sentences (e.g. If I cannot do my job to perfection, then everyone will think I am a failure’) or of statements that contain ‘should’ (e.g. I should be the life and soul of a party) (Greenberger & Padesky 1995). Conditional beliefs lie beneath and shape the automatic thoughts that pop into our head; they can be viewed as guiding principles that affect our daily life experiences. All lives are governed by beliefs to a certain extent and these in turn govern our behaviour. Some people, however, develop unhelpful beliefs about a range of issues and these can often significantly affect the way in which they lead their lives.

Whilst unhelpful beliefs can be varied in nature, there are several categories in which the most common beliefs can be placed. It is often helpful to discuss these categories with clients to see if any of them resonate with their experience (Box 12.2).